Communicable Disease Questions for HPC DonorsAre you1. Currently taking an antibiotic?2. Currently taking any other medication for an infection?

Please read the Medication Deferral List.3. Are you now taking or have you ever taken any medications on the Medication List?

4. Have you read the educational materials?

In the past 8 weeks have you5. Had any vaccinations or other shots? 6. Had contact with someone who had a smallpox vaccination?

In the past 12 months have you7. Been told by a healthcare professional that you have West Nile Virus infection?8. Had a blood transfusion?9. Come into contact with someone else’s blood? 10. Had an accidental needle-stick? 11. Had a tissue transplant or graft such as bone or skin?12. Had sexual contact with anyone who has HIV/AIDS or has had a positive test for the HIV/AIDS virus?13. Had sexual contact with a prostitute or anyone else who takes money or drugs or other payment for sex?14. Had sexual contact with anyone who has ever used needles to take drugs or steroids, or anything not prescribed by their doctor?15. Had sexual contact with anyone who has hemophilia or has used clotting factor concentrates? 16. Female donors: Had sexual contact with a male who has ever had sexual contact with another male? (Males: check “I am male.”)17. Had sexual contact with a person who has hepatitis?18. Lived with a person who has hepatitis?19. Had a tattoo?20. Had ear or body piercing?21. Had or been treated for syphilis or gonorrhea?22. Been in juvenile detention, lockup, jail, or prison for more than 72 hours?

In the past three years have you23. Been outside the United States or Canada?

In the past 5 years, have you24. Received money, drugs, or other payment for sex?

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